Morbid Curiosities

Ambarish Satwik on his days as a student of anatomy, poking around in cadavers and studying photographs of extravagantly diseased bodies

Untitled 2012 || Nityan Unnikrishnan

There was a time when I was in thrall to a photograph of syphylitic noselessness. It was a late-19th-century photograph of a young woman, quite clearly patrician, and I remember being bewildered by the operatic calamity that was the hole in her face. The external nose was completely absent following an ulcerative destruction. Most of the nasal septum had been eaten away; what could be seen were the triangular bony rims of the nares. Her noselessness marked her body as corrupt and dangerous, as a legatee and keeper of syphilis. It warned against the quality of her flesh, against her virtue, or that of her husband’s. And withal, her eyes were still lambent with the pride and assurance of the well-born.

She seemed to occupy a world of Victorian moral fiction. The photograph was from the collection of the surgeon Jonathan Hutchinson—annalist, analyst and registrar of all things syphilitic. In the accompanying text he warned that her sunken nose would be transmitted to her newborn, who would, from infancy, bear the insignia of corruption in the form of peg-shaped teeth, saddle-nose, sabre shin and blindness from clouded corneas.

She was in an old book, crumbling at the edges, that belonged to a particularly misanthropic professor of surgery. I can no longer be sure if it was a photograph or a picture of a daguerreotype or even a watercolour illustration; I remember her as a sitter in the great continuum of Victorian portrait culture. In my recreation after all these years, I haven’t added features to her facies, or diminished them or changed the angle from which I see her inside my head. In my inner cinema, her form, structure, face and personality are exactly what I encountered on Hutchinson’s plates years ago. What I remember like a mnemonic is her diseased physiognomy; what tugs at the margins of my memory is the traffic carried on her face.

*

Mrs Mudholkar, Professor and Head, Department of Anatomy, Government Medical College, Miraj, whatever her private virtues might have been, will be best remembered for her tortoiseshell-rimmed spectacles, her muscled forearms, the air of restrained severity with which she gazed upon her students and for her rather imaginative retelling of the Edinburgh anatomy scandal of 1828 in her introductory lecture at the beginning of term.

Just as the Brothers Grimm rendered all children who read their stories German, gave them German nightmares, German fears, Mrs Mudholkar rendered our anatomical iconography Edinburghian. And she did this in the Queen’s English in the Received Pronunciation of southwestern Maharashtra.

“The pursuit of anatomical reality,” she would say, assuming a statuesque pose at the pulpit, “is about the wilful mutilation of the body of another human.” One could learn anatomy only by cutting up corpses, and our corpses would be rationed by her. “Seven students to a cadaver and consider yourselves lucky.” These were unclaimed pauper corpses. Given to us according to the Mysore Anatomy Act, 1957, that defined an “unclaimed body” as the body of a person who dies in a hospital, prison or public place to which members of the public have access, and which has not been claimed by any person interested within such time as may be prescribed.

As the anatomy legislation entered the frame of interpretation, Mudholkar would evoke 19th-century Edinburgh and its medical underworld. Before the Anatomy Act of 1832 increased the supply to include bodies of the destitute (we were told), the only legal stock of corpses for anatomy tutorials in the United Kingdom consisted of those condemned to Death and Dissection by the courts. Henry VIII, famously, had a four-felon grant: a total of four executed criminals for all the anatomy schools of Edinburgh per year. The judicially granted sources of corpses for dissection were obviously inadequate; the shortfall was made up by grave-robbing. The corpse became a commodity. It was routine practice for relatives to take turns to watch over the grave for three nights after burial to obstruct any kind of violation.

The traffic in human remains for anatomical dissections led not just to entrepreneurial exhumations by gangs of professional resurrectionists, but also murder. In 1828, the duo of William Hare and William Burke, Irish immigrants and self-styled entrepreneurs, committed 16 murders to supply “fresh” cadavers to the celebrated Edinburgh anatomist Robert Knox for his demonstrative tuitions. Burke and Hare smothered their victims in a manner that left no trace of violence on the body. The corpses were delivered in the dark to Knox’s establishment where roughly eight pounds were paid per transaction.

Primed by Mrs Mudholkar’s prefatory commentary, we dissected, with cold-blooded callousness, the remains of vagrants and derelicts of Sangli district for a year and a half. But before we did that, even before we stepped into the formaldehyded air of the dissection hall or commenced low Latin murmurs from the standard bestiary of nomenclature, we had to procure a set of disarticulate bones, as mandated in the curriculum. A personal set was considered preferable. I purchased mine from a young man called Mamdu. He wore a clean embroidered shirt. The bones came in a jute gunny sack, all 206 of them, including the coccyx and the terminal phalanges, covered in mud and incubating mites.

As flâneurs of anatomy, for the first three days we alleviated the boredom by traipsing through the tissues, indiscriminately taking in the sights, making superficial incisions. The actual dissection, when it began, had a proper prescriptive grammar, framed by another Edinburgh gent from the 19th century. Daniel Cunningham’s Manual of Practical Anatomy would be propped up against the cadavers as we lurched inside. It asked us not to passively survey but to gape and stare instead. To develop the anatomical gaze. To follow the text like scripture.

It was a bit like the sport of orienteering, except the terrain we were navigating was the insides of a dead person: “Trace the supraclavicular nerves upwards, through the deep fascia, to the posterior border of the stereo mastoid; then, pulling them aside, cut through the superficial layer of the deep fascia immediately above the clavicle and along the posterior border of the sterno-mastoid, and turn it upwards. Introduce the handle of the scalpel behind the clavicle and note that it can be passed downwards as far as the posterior border of the lower surface of the bone. Its further progress is barred by the attachment of the second layer of the deep fascia to that border where it blends with the posterior lamella of the costco-coracoid membrane. Pass the handle of the knife forwards deep to the sternomastoid, and note that, without using any great force, it can be pushed medially until it crosses the median plane…”

Without illustrations, without a demonstrator, it was impossible to understand this, particularly for those of us from provincial Maharashtra who weren’t even notionally Anglophonic. There were illustrations, painstakingly made by very skilled draughtsmen, under Cunningham’s scrupulous eye, but not as many as we would’ve wanted.

Now that I’m past this grand tableau of cadaveric tapestry, I wonder what aesthetic and cultural values were lugged into illustrations made about a hundred years ago, in the first age of the photograph? How did these plates of still life, these topographic maps of anatomy, inform us about what we might actually see in our own dissected dead? As fledgling learners did we properly “read” these images that effigised the body?

Was Cunningham’s language imperialistic? Perhaps. It was the pungently arcane prose of the monolingual native English speaker. Is not the purpose of descriptive prose to provide easement? To make something knowable? For those who could not comprehend without images, Cunningham’s instruction was a demonstration of power. I also wonder why Mudholkar said “the pursuit of anatomical reality” and not something else, like the study of anatomy. I know she said that because I have it written down in my Cunningham’s.

*

Hoshedar Ramyar Tata, Professor of Surgery, was my Lord and Master for three years, during my residency. No man is a hero to his valet, but that, as Hegel has clarified, is not because the hero is not a hero, but because the valet is a valet.

He was probably the fastest knife distal to the Vindhyas (he could shell out the prostate in eight minutes—it was an astonishment to behold), was simultaneously absurd and sublime, vulgar and grand, and something of a manic record-keeper. Actually his residents over the years kept it for him, lest a rock be conveyed up their arses. He was handcuffed to the idea of the clinical photograph; he’d get everything photographed: lesions of the tongue and the anal verge, great fungating tumours, faecal and urinary specimens in all sorts of merry colours, indeterminate genitalia, unsightly fistulae, bony deformities, yawning wounds, congenital malformations, aneurysms at the point of rupture, bronchoscopically retrieved foreign bodies, hernias where you’d least expect them, and so on. It was a kind of portraiture for him, of the physically anomalous, of photogenic morbid phenomena, of patients exhibiting characteristic clinical findings. Most of the chronic cases were photographed in the Rembrandt lighting of the far end of Ward 6 with the daylight falling on the subject through the window and the fill light coming in from the glossy white wall tiles on the other side.

Some of the photographs from his collection we’d seen on so many occasions that the sitters seemed like celebrities. The process of diagnosing surgical entities, we came to realise, was basically post-hoc mother wit, what the old man called the purple cow theory of education. If you know purple, if you know cow, then you know a purple cow when you see one. It amounted to, in a sense, a posteriori visual literacy. Harking back to a cardboard-mounted old photograph from his “acute conditions” folder, I was able to diagnose, as a first-year rookie, a case of Ludwig’s Angina in the Casualty. Ludwig’s Angina aka Morbus Strangularis is a rapidly spreading, life-threatening abscess involving the floor of the mouth. It has the potential of internally strangulating the airway if allowed to ripen unchecked.

In Tata’s private collection, the clinical photograph was the bastard child of the studio portrait. The patient’s face was always visible regardless of the part or the condition being photographed. It was as though he did not believe in diminishing the sufferer to his or her photographed lesion. There were abstracted parts, but there was always one full-length photograph. No attempt was made to anonymise the subject. No white discs on the face, no need for draping or masking or concealment of genitalia.

If a portrait is a gussied-up representation of self that serves to present one’s identity, Tata, like his precursors, was making an allowance for the morbid anatomy of his subjects. The form and structure of their pathology, their abjectness in that moment, was part of their identity.

For three years, as a resident, I preyed upon HR Tata’s archives: his cabinet cards, slides, private journals, surgical ward records, intra-operative photographs—a harvest of a little over 35 years. Each one of those clinical images is seared in my memory. Those anomalies have been stunningly reified in my mind, mothballed as aide-mémoire. Purple cows yoked to their sufferers. Reviewing the inner cinema, it isn’t atypical that the faces of his subjects, their lineaments, have given each condition its mnemonic glue.

This piece was published in Oct-Dec 2016 issue of The Indian Quarterly.

About the author

Ambarish Satwik is a Delhi-based vascular surgeon and writer. His debut novel, Perineum: Nether Parts of the Empire (Penguin, 2007), is a rogue sexual history of the British colonial project in India. He’s currently working on a collection of burlesque, illustrated essays to be published by HarperCollins next year. His polemical commentary appears often in The Hindu BLink.